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Sport participation and Upper Respiratory Infection

My own 9 years old daughter is a competitive swimmer, recreational gymnast, and an ice skater. In summary, a competitive over-achiever! As recently as last week, she began complaining of sore throat pain when she was swallowing, abdominal pain and severe headache. No fever.

I promptly conducted full-comprehensive exam and rapid group strep test.

She tested positive for group A strep, aka strep throat. The first question that she had for me, after long debate about which antibiotic flavor she should get, was When can I return to my swim practice?

That’s the question (insert your favorite sport) I hear quite frequently from young athletes and their parents. Thinking about it, I decided to summarize and share with you some of the general guidelines here. Remember, this are general guidelines and should be taken as such, if you have any questions or concerns about your child you should bring them for evaluation.

In general, athletes with mild upper respiratory infection can continue to play as long as they are able to do so. They are more susceptible to dehydration during or after infection than general population, though, and for that reason, athletes should make an effort to stay well-hydrated (a topic that deserves its own post and time – but one thing at the time)

When deciding if athlete can return to sports, most physicians use the “neck check”. A patient can return to sports if their symptoms are all “above the neck” (e.g. sore throat (viral) or stuffy nose). If they have symptoms “below the neck” (e.g. fever, feeling sick, chest congestion, or gastrointestinal symptoms), they should refrain from participation until symptoms resolve.

Cough is tricky and if it is due to post-nasal drip, then “above the neck” recommendations apply. However, if it is from pneumonia, then “below the neck” recommendations should be used.

Athlete can return to sports once fever-free off antipyretics for minimum of one day, well-hydrated, and feeling physically well. For young athletes that have bacterial infection, they should be afebrile and on antibiotics for at least 24 hours, well- hydrated (see the theme here?), and feeling physically well prior to returning to sport activities.

Once athlete is cleared to return to physical activity, they should transition back to play, initially attempting only 10-15 min of light exercise. If they feel well during this exercise trial, they may proceed as tolerated.

The above algorithm will not apply in someone who has mononucleosis. Thus, if ever uncertain seek your doctor’s advice before pre-initiation of activity.